Vertically unstable type III odontoid fractures: Case report

Andrew Jea, Claudio Tatsui, Hamad Farhat, Steve Vanni, Allan D. Levi

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


OBJECTIVE AND IMPORTANCE: Type III odontoid fractures are generally thought of as unstable fractures that can be successfully treated with an external orthosis. However, there is a rare subtype of Type III odontoid fractures that is similar in the degree of instability to atlanto-occipital dislocation injuries. Not recognizing or not treating this injury urgently and aggressively could lead to devastating iatrogenic neurological injuries such as quadriplegia and fatal lower brainstem palsies. CLINICAL PRESENTATION: We present the case of a 73-year-old woman with a vertically distracted Type III odontoid fracture and associated quadriparesis and brainstem deficits. The patient was kept in a rigid collar, placed in a kinematic bed, and admitted to the trauma service for the management of her life-threatening systemic injuries. Traction was not applied. INTERVENTION: As soon as the patient was systemically stable, she was taken to the operating room for C1-C2 fixation with a screw-rod construct supplemented by cable and structural iliac crest bone graft. CONCLUSION: Delayed recognition of this subtype of Type III odontoid fracture could have fatal or highly morbid consequences, such as quadriparesis/-plegia, lower brainstem dysfunction, and ventilator-dependence, for the patient. It is important to keep a high level of suspicion for this unusual subtype of Type III odontoid fracture.

Original languageEnglish (US)
Pages (from-to)E797.1-E797.5
Issue number4
StatePublished - Apr 1 2006


  • Cervical spine fracture
  • Type III odontoid fracture
  • Unstable spine fracture

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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